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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300603868
Report Date: 05/12/2023
Date Signed: 05/12/2023 01:16:19 PM

Document Has Been Signed on 05/12/2023 01:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:FULLERTON COLLEGE CHILD DEVELOPMENT LABORATORY SCHFACILITY NUMBER:
300603868
ADMINISTRATOR:MARIETTA GILLIARDFACILITY TYPE:
850
ADDRESS:321 E. CHAPMAN AVE.TELEPHONE:
(714) 992-7070
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 36DATE:
05/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Site Supervisor Elvia Deanda TIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Giselle Lucero and Dianna Valdez conducted a case management inspection to follow up on a self-reported unusual incident that was submitted to CCL Regional Licensing Office on 04/21/2023. LPAs met with Site Supervisor Elvia Deanda.

Upon arrival there were 5 staff present 36 children in care. A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

It was reported by Director Marietta Gillard that on 04/20/2023, while staff #1 (S1) was helping parent #1 (P1) with the sign out procedure, Child #1 (C1) walked away from the playground and was found sitting alone on the ramp by classroom #2 by P1. Director stated C1 was left unattended for approximately 2-3 minutes.

During this investigation, LPA interviewed 4 staff and 2 children and obtained a copy of the children roster, an individual educational plan (IEP) of C1, sign in and out sheet and took pictures of the lower play yard, the ramp where C1 was located, exterior of classroom #2, and the view from the ramp to the lower yard.
S1 stated she was supervising 11 children at the time of the incident outside in the play yard. S1 stated she was helping P1 sign out their child. S1 believes that while they were assisting the parent and looking down at the sign-in/out app on P1’s phone, C1 walked out of the play area and up the ramp. S1 stated they remembered seeing C1 running around the circle path before helping P1. S1 stated when they were done, P1 started walking away and up the ramp and that’s when P1 saw C1 sitting alone on the ramp in front of classroom #2. P1 yelled for S1’s attention and informed them C1 was alone on the ramp to classroom #2. P1 walked C1 back to the play yard. S1 stated C1 was left unattended for approximately 2-3 minutes.
LPA interviewed 4 staff. All 4 interviewed staff acknowledged C1 walked away from the play yard and was left unattended for approximately 2-4 minutes on the ramp to classroom #2.
(continue to next page)
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Giselle Lucero
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FULLERTON COLLEGE CHILD DEVELOPMENT LABORATORY SCH
FACILITY NUMBER: 300603868
VISIT DATE: 05/12/2023
NARRATIVE
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(Page 2)
Based on the information gathered from interviews conducted with staff, observation of the play yard and ramp, and records reviewed. It was determined that C1 walked away from play yard and was left unattended on the ramp to classroom #2 for approximately 2-4 minutes.

The facility was not in compliance of the California Code of Regulations, Title 22, Division 12. The following citation Responsibility for Providing Care and Supervision section 101229(a)(1) was issued today on the attached LIC 809D. The regulation states “No child(ren) shall be left without the supervision of a teacher at any time. Supervision shall include visual observation.”

LPA Lucero informed Site Supervisor Elvia Deanda that this report dated 05/12/2023 document 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Lucero informed Site Supervisor Elvia Deanda to provide a copy of this licensing report dated 05/12/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Site Supervisor Elvia Deanda A notice of site visit was given and must remain posted for 30 days.

Appeal Rights and deficiencies were discussed. The site supervisor was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

End of report.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Giselle Lucero
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/12/2023 01:16 PM - It Cannot Be Edited


Created By: Giselle Lucero On 05/12/2023 at 12:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: FULLERTON COLLEGE CHILD DEVELOPMENT LABORATORY SCH
FACILITY NUMBER: 300603868

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/12/2023
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1)No child(ren) shall be left without the supervision of a teacher at any time....Supervision shall include visual observation.
This requirement was not met as evidenced by:
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Site Supervisor Elvia Deanda stated they stationed staff at every opening in the play yard and moved a bench to create a barrier. Staff meeting was held on 05/03/2023 with reminders to keep count every 15 minutes. Director Marietta Gillard sent meeting agenda and staff signatures to LPA via email.
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Based on LPA's interviews with 4 staff and observation of the physical plant it was determined C1 wandered away from the lower play yard under the supervision of S1 and was found alone on the ramp to classroom #2 by P1. C1 was left unattended for approximately 2-4 minutes. This imposes an immediate health and safety risk to children in care.
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Site supervisor stated white boards were placed in play yard that is to be updated frequently by staff with the number of children. Site supervisor also stated staff communication through walkie talkies has increased when a child has been picked up.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Judy Hanson
LICENSING EVALUATOR NAME:Giselle Lucero
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023


LIC809 (FAS) - (06/04)
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